A comparative study of totally laparoscopic distal gastrectomy A comparative study of totally laparoscopic distal gastrectomy patients: Short-term operative outcomes at a high-volume center

• Published in: 中国癌症研究（英文版） Vol. 30; no. 5; pp. 546 - 552
• Main Authors: Adriana Vaz Safatle-Ribeiro, Elisa Ryoka Baba, Rodrigo Corsato Scomparin, Sheila Friedrich Faraj, Marcelo Simas de Lima, Luciano Lenz, Bruno Costa Martins, Carla Gusmon, Fábio Shiguehissa Kawaguti, Caterina Pennacchi, Bruno Zilberstein, Ulysses Ribeiro Jr, Fauze Maluf-Filho
• Format: Journal Article
• Language: English
• Published: Endoscopy Unit of Department of Gastroenterology, S(a)o Paulo Cancer Institute, University of S(a)o Paulo Medical School(ICESP-HCFMUSP),S(a)o Paulo 01246-000, Brazil 2018
• Subjects: gastric cancer; Probe-based confocal endomicroscopy; intestinal metaplasia; atrophy; gastric adenoma; endoscopic resection
• ISSN: 1000-9604
• DOI: 10.21147/j.issn.1000-9604.2018.05.08

Objective:Probe-based confocal laser endomicroscopy (pCLE) technique may improve the diagnosis of gastric mucosal lesions allowing acquisition of high-resolution in vivo images at the cellular and microvascular levels.This study aims to evaluate the accuracy of pCLE for the differential diagnosis of non-neoplastic and neoplastic gastric lesions.Methods:Twenty gastric mucosal lesions from 10 patients were evaluated during endoscopic procedure and were examined by pCLE.Diagnostic pCLE was followed by biopsies or endoscopic resection of suspected lesions.A senior pathologist evaluated the specimens and was blinded to the pCLE results.Results:Patients' mean age was 68.3 (range,42-83) years and six were men.Thirteen suspicions flat or elevated lesions (classified as 0-Ⅰs,0-Ⅱa or 0-Ⅱa +Ⅱc) and seven pre-malignant lesions (atrophy and intestinal metaplasia) were evaluated.One patient was studied during his long-term follow-up after partial gastrectomy and presented severe atrophy,intestinal metaplasia,and xanthomas at the stump mucosa.The location of gastric lesions was in the body (n=10 lesions),the antrum (n=9) and the incisura angularis (n=l).All neoplastic lesions and all but one benign lesion were properly diagnosed by pCLE.pCLE incorrectly diagnosed one small antrum lesion as adenoma,however the final diagnosis was intestinal metaplasia.The final histological diagnosis was neoplastic in 9 and benign lesions in 11.In this small case series,pCLE accuracy was 95％ (19/20 lesions).Conclusions:pCLE is accurate for real time histology of gastric lesions.pCLE may change the management of patients with gastric mucosal lesions,guiding biopsies and endoscopic resection,and avoiding further diagnostic workup or unnecessary therapy.